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McCann NC, LaRochelle MR, Morgan JR. Out-of-pocket spending and health care utilization associated with initiation of different medications for opioid use disorder: Findings from a national commercially insured cohort. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209281. [PMID: 38122988 PMCID: PMC10947919 DOI: 10.1016/j.josat.2023.209281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/05/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Buprenorphine and naltrexone are effective medications for opioid use disorder (MOUD). Naltrexone requires complete detoxification from opioids before initiation while buprenorphine does not, which leads to a differential clinical induction challenge. Few studies have evaluated economic costs associated with MOUD initiation. METHODS We conducted a retrospective cohort analysis using the 2014-2019 Merative MarketScan database. We included individuals diagnosed with opioid use, abuse, or dependence from 2014 to 2019 who initiated one of three MOUD types: 1) buprenorphine, 2) extended-release naltrexone, or 3) oral naltrexone. We calculated total and monthly out-of-pocket spending, for overall and MOUD-specific claims, for the three months prior through three months after MOUD initiation. We also calculated utilization of detoxification, inpatient, and outpatient services monthly over this period. RESULTS Our cohort included 27,133 individuals; 19,536, 1886, and 5711 initiated buprenorphine, extended-release naltrexone, and oral naltrexone, respectively. Individuals who initiated naltrexone had the highest out-of-pocket spending over the study period. MOUD-specific spending did not contribute substantially to total out-of-pocket spending. Difference in overall spending by MOUD type was driven by a subset of individuals who initiated naltrexone and had very high out-of-pocket spending in the month prior to MOUD initiation. In this month, mean monthly out-of-pocket spending for high-spenders (above 90th percentile within MOUD type category) was $5734 (95 % confidence interval [CI]: $5181-$6286) and $4622 (95 % CI: $4161-$5082) for those who initiated oral and extended-release naltrexone, respectively, compared with $1852 (95 % CI: $1754-$1950) for those who initiated buprenorphine. In the month prior to MOUD initiation, those who initiated naltrexone also had higher detoxification, inpatient, and outpatient episode/visit frequency. In the month prior to initiation, 28.8 % (95 % CI: 27.7 %-30.0 %) and 25.5 % (95 % CI: 23.6 %-27.5 %) of individuals who initiated oral and extended-release naltrexone had detoxification episodes, compared with 9.7 % (95 % CI: 9.3 %-10.1 %) of those who initiated buprenorphine. CONCLUSION Findings suggest that individuals who initiated naltrexone utilized more intensive health services, including detoxification, in the period prior to MOUD initiation, resulting in significantly higher out-of-pocket spending. Out-of-pocket spending is a patient-centered outcome reflecting potential patient burden. Our results should be considered as part of the shared decision-making process between patients and providers when choosing treatment for OUD.
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Affiliation(s)
- Nicole C McCann
- Department of Health Law, Policy, and Management, Boston University School of Public Health, United States of America.
| | - Marc R LaRochelle
- Grayken Center for Addiction, Boston Medical Center, United States of America; Department of Medicine, Boston University School of Medicine, United States of America
| | - Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, United States of America
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Williams AR, Rowe C, Minarik L, Gray Z, Murphy SM, Pincus HA. Use of in-network insurance benefits is critical for improving retention in telehealth-based buprenorphine treatment. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae009. [PMID: 38450044 PMCID: PMC10914333 DOI: 10.1093/haschl/qxae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
An empiric evidence base is lacking regarding the relationship between insurance status, payment source, and outcomes among patients with opioid use disorder (OUD) on telehealth platforms. Such information gaps may lead to unintended impacts of policy changes. Following the phase-out of the COVID-19 Public Health Emergency, states were allowed to redetermine Medicaid eligibility and disenroll individuals. Yet, financial barriers remain a common and significant hurdle for patients with OUD and are associated with worse outcomes. We studied 3842 patients entering care in 2022 at Ophelia Health, one of the nation's largest OUD telehealth companies, to assess associations between insurance status and 6-month retention. In multivariable analyses, in-network patients who could use insurance benefits were more likely to be retained compared with cash-pay patients (adjusted risk ratio [aRR]: 1.50; 95% CI: 1.40-1.62; P < .001). Among a subsample of 882 patients for whom more detailed insurance data were available (due to phased-in electronic health record updates), in-network patients were also more likely to be retained at 6 months compared with insured, yet out-of-network patients (aRR: 1.86; 95% CI: 1.54-2.23; P < .001). Findings show that insurance status, and specifically the use of in-network benefits, is associated with superior retention and suggest that Medicaid disenrollment and insurance plan hesitation to engage with telehealth providers may undermine the nation's response to the opioid crisis.
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Affiliation(s)
- Arthur Robin Williams
- Ophelia Health, Inc, New York, NY 10003, United States
- Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, United States
| | | | - Lexie Minarik
- Ophelia Health, Inc, New York, NY 10003, United States
| | - Zack Gray
- Ophelia Health, Inc, New York, NY 10003, United States
| | - Sean M Murphy
- Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Harold A Pincus
- Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, United States
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Lee JS, Han S, Therrien NL, Park C, Luo F, Essien UR. Trends in Drug Spending of Oral Anticoagulants for Atrial Fibrillation, 2014-2021. Am J Prev Med 2024; 66:463-472. [PMID: 37866490 PMCID: PMC10922581 DOI: 10.1016/j.amepre.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION This study documents cost trends in oral anticoagulants (OAC) in patients with newly diagnosed atrial fibrillation. METHODS Using MarketScan databases, the mean annual patients' out-of-pocket costs, insurance payments, and the proportion of patients initiating OAC within 90 days from atrial fibrillation diagnosis were calculated from July 2014 to June 2021. Costs of OACs (apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin) and the payments by three insurance types (commercial payers, Medicare, and Medicaid) were calculated. Patients' out-of-pocket costs and insurance payments were adjusted to 2021 prices. Joinpoint regression models were used to test trends of outcomes and average annual percent changes (AAPC) were reported. Data analyses were performed in 2022-2023. RESULTS From July 2014 to June 2021, the mean annual out-of-pocket costs of any OAC increased for commercial insurance (AAPC 3.0%) and Medicare (AAPC 5.1%) but decreased for Medicaid (AAPC -3.3%). The mean annual insurance payments for any OAC significantly increased for all insurance groups (AAPC 13.1% [95% CI 11.3-15.0] for Medicare; AAPC 11.8% [95% CI 8.0-15.6] for commercial insurance; and AAPC 16.3% [95% CI 11.3-21.4] for Medicaid). The initiation of any OAC increased (AAPC 7.3% for commercial insurance; AAPC 10.2% for Medicare; AAPC 5.3% for Medicaid). CONCLUSIONS There was a substantial increase in the overall cost burden of OACs and OAC initiation rates in patients with newly diagnosed atrial fibrillation in 2014-2021; these findings provide insights into the current and anticipated impact of rising drug prices on patients' and payers' financial burden.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sola Han
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, Texas
| | - Nicole L Therrien
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chanhyun Park
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, Texas
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Utibe R Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, California; Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California
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Jiang X, Strahan AE, Zhang K, Guy GP. Trends in Out-of-Pocket Costs for and Characteristics of Pharmacy-Dispensed Naloxone by Payer Type. JAMA 2024; 331:700-702. [PMID: 38285437 PMCID: PMC10825780 DOI: 10.1001/jama.2023.26969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
This study examines mean yearly out-of-pocket cost for naloxone dispensed from retail pharmacies by payer between 2018 and 2022 and by prescription characteristics and payer in 2022.
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Affiliation(s)
- Xinyi Jiang
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea E. Strahan
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kun Zhang
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery P. Guy
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Jiang X, Govoni TD, Illg Z, Connolly S, Green JL, Guy GP. Sources of nonmedically used prescription psychotherapeutic drugs using real-world data from adolescents and adults assessed for substance use treatment--2014-2022. Res Social Adm Pharm 2024; 20:209-214. [PMID: 37919218 PMCID: PMC10843771 DOI: 10.1016/j.sapharm.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/15/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Nonmedical use (NMU) of prescription psychotherapeutic drugs (PPD) may increase risk for significant morbidity and mortality in the overdose crisis. OBJECTIVE This study examines sources of PPD using real-world data from adolescents and adults reporting past 30-day NMU of PPDs. METHODS A convenience sample of individuals aged ≥10 years assessed for substance use disorders (SUD) treatment was analyzed using the 2014-2022 National Addictions Vigilance Intervention and Prevention Program datasets. PPD include prescription opioids, prescription tranquilizers/sedatives, and prescription stimulants. RESULTS Overall, among assessments of adolescents aged 10-18 years (N = 1991) and young adults aged 19-24 years (N = 15,166), "family/friend" (46.08-47.41 %) and "dealer" (33.82-42.71 %) were the most common sources. Among assessments of adults aged ≥25 years (N = 89,225), "own prescription" was the most common source and increased in frequency as age increased. Across all age groups, "family/friend" was the most frequent source for all drug classes (41.96-48.76 %) except for nonmedically used buprenorphine/methadone, for which "own prescription" was the most common source (51.85 %) among adults. CONCLUSIONS Our study demonstrates heterogeneity in sources of nonmedically used PPD across age groups. Tailored prevention strategies for different age groups and improving timely access to medical care to ensure proper treatment of chronic medical conditions including SUD are needed.
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Affiliation(s)
- Xinyi Jiang
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.
| | - Taryn Dailey Govoni
- Inflexxion, a division of Uprise Health, 2 Park Plaza, Suite 1200, Irvine, CA, 92614, USA
| | - Zachary Illg
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Sarah Connolly
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Jody L Green
- Inflexxion, a division of Uprise Health, 2 Park Plaza, Suite 1200, Irvine, CA, 92614, USA
| | - Gery P Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
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Haber LA, Nguyen OK, Taub J, Martin M. Policy in clinical practice: Elimination of the buprenorphine "X-waiver". J Hosp Med 2023; 18:931-933. [PMID: 37545111 DOI: 10.1002/jhm.13176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Lawrence A Haber
- Department of Medicine, Division of Hospital Medicine, Denver Health and Hospital Authority, University of Colorado, Denver, Colorado, USA
| | - Oanh K Nguyen
- Department of Medicine, Division of Hospital Medicine, San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA
| | - Julie Taub
- Department of Medicine, Division of Hospital Medicine, Denver Health and Hospital Authority, University of Colorado, Denver, Colorado, USA
| | - Marlene Martin
- Department of Medicine, Division of Hospital Medicine, San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California, USA
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Terranella A, Guy G, Strahan A, Mikosz C. Out-of-Pocket Costs and Payer Types for Buprenorphine Among US Youth Aged 12 to 19 Years. JAMA Pediatr 2023; 177:1096-1098. [PMID: 37548969 PMCID: PMC10407759 DOI: 10.1001/jamapediatrics.2023.2376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/06/2023] [Indexed: 08/08/2023]
Abstract
This cross-sectional study examines out-of-pocket costs and payer types for buprenorphine prescriptions filled for youth aged 12 to 19 years at US retail pharmacies.
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Affiliation(s)
- Andrew Terranella
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery Guy
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Strahan
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina Mikosz
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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